Weber M, Dietrich M, Hillmann A
Abteilung für Sarkome und muskuloskelettale Tumore, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Deutschland.
Orthopadie (Heidelb). 2025 Oct;54(10):825-833. doi: 10.1007/s00132-025-04667-y. Epub 2025 Jul 2.
Abnormal X‑ray images and magnetic resonance imaging (MRI) findings in older patients are common and require prompt evaluation to distinguish malignant diseases from harmless incidental findings. A thorough medical history, including pre-existing diseases and previous imaging, is essential. Conventional X‑ray images provide initial indications of lesion dignity using the Lodwick classification. The diagnostics are supplemented by contrast-enhanced MRI and, if necessary, additional CT scans. The most common malignant bone tumors in old age are metastases, followed by lymphomas, plasmacytomas and, less frequently, primary bone tumors. The fracture risk of the extremities can be assessed using the Mirels score and using the spinal instability neoplastic score (SINS) regarding the spine. In cases of unclear findings, a biopsy is necessary for further evaluation and should be performed at a specialized tumor center. The treatment depends on the tumor entity and staging and includes surgical procedures, radiotherapy and chemotherapy. The most important indicator of a pathological fracture is an inadequate trauma mechanism.
老年患者的异常X线图像和磁共振成像（MRI）表现很常见，需要及时评估以区分恶性疾病和无害的偶然发现。全面的病史，包括既往疾病和既往影像学检查，至关重要。传统X线图像使用洛德维克分类法提供病变严重程度的初步指征。诊断通过增强MRI补充，必要时进行额外的CT扫描。老年最常见的恶性骨肿瘤是转移瘤，其次是淋巴瘤、浆细胞瘤，原发性骨肿瘤较少见。四肢骨折风险可使用米雷尔斯评分评估，脊柱骨折风险可使用脊柱不稳定肿瘤评分（SINS）评估。在检查结果不明确的情况下，需要进行活检以进一步评估，活检应在专业肿瘤中心进行。治疗取决于肿瘤类型和分期，包括手术、放疗和化疗。病理性骨折最重要的指标是外伤机制不充分。
